On-Call Physicians at California Emergency Departments: Problems and Potential Solutions

Lois Green
Glenn Melnick, Blue Cross of Calif. Chair in Health Care Finance; professor of public policy, Univ. of Southern Calif.
Amar Nawathe


This is archived content, for historical reference only.

Providing adequate on-call coverage is a serious challenge for many California hospitals. The patchwork of call-panel arrangements is unwieldy and expensive and may compromise the quality of care for patients in the emergency department. For years, the system has been widely recognized as inefficient and dangerously unstable.

With funding from the California HealthCare Foundation, The Performance Alliance, in collaboration with the University of Southern California Center for Health Financing, Policy and Management, examined why the system is unstable, how emergency departments are coping, and possible strategies for improving on-call coverage.

The authors summarize their findings in this issue brief. They conclude that no single solution will resolve the many on-call panel issues, but that a variety of strategies are needed at both the state and individual hospital level, including:

  • Legislative action, such as payment standards;
  • Regional competitive contracting;
  • Instituting mandatory on-call duty for hospital medical staffs;
  • Creating physician compensation incentives such as tier-based stipends or productivity-based guarantees; and
  • Restructuring the delivery of on-call services through use of hospitalists or physician assistants; regional physician pools for high demand, limited supply services; and transfer agreements among hospitals.

Required by state and federal law to assure access to specialty services, hospitals have seen the on-call crisis intensify as a result of increasing visits to emergency departments and a lack of reimbursement for uninsured, underinsured, and self-pay patients.

The complete issue brief is available under Document Downloads.